scholarly journals Development and Application of Nursing Risk Management Evaluation System

2021 ◽  
Author(s):  
Li Xiaoyu ◽  
Li Jinxue ◽  
Jiang Fengqiong ◽  
Zhu Yan ◽  
Ye Qiaohua
Keyword(s):  
Risk Assessment ◽  
Risk Management ◽  
High Risk ◽  
Evaluation System ◽  
Assessment System ◽  
High Risk Patients ◽  
Clinical Nurses ◽  
Standard Management ◽  
Risk Patients ◽  
Set Up

Objective: to construct an integrated nursing risk management assessment system, standardize nursing risk assessment and management process, and improve the implementation rate of nursing risk assessment and nursing safety quality. Methods: a special team was set up to construct an integrated nursing risk management and assessment system, including management personnel, clinical nurses and information engineers, to analyze the problems existing in the old nursing risk assessment and design an integrated nursing risk management and assessment system. Results: the integrated nursing risk management assessment system was applied in all wards of the hospital from July 2019 to September 2019, and 25,778 cases were evaluated. It has the advantages of intelligence, integration, convenient operation, historical score query, guiding standard management of high-risk patients. Conclusion: the intelligence, integration and standardization of the integrated nursing risk management assessment system can improve nursing efficiency, standardize nursing risk management, improve nursing staff satisfaction, and reduce the incidence of nursing adverse events in high-risk patients.

scholarly journals Validation of the STRATIFY Falls Risk Assessment Tool in a Japanese Acute Care Hospital Setting

2016 ◽  
Vol 9 (2) ◽  
pp. 277 ◽  
Author(s):  
Shin-ichi Toyabe ◽  
Thoshihiro Kaneko ◽  
Akira Suzuki ◽  
Ayuko Yasuda
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Acute Care ◽  
Hospital Setting ◽  
Assessment System ◽  
Low Risk ◽  
Falls Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Inpatient Falls

<p>Patient falls are the most frequent adverse events that occur in a hospital. Prevention of inpatient falls is performed by a strategy to target patients at high risk for falls determined by a falls risk assessment system such as the STRATIFY tool. However, the performance of the STRATIFY tool in a Japanese hospital setting has not been determined. We tried to verify the performance of the STRATIFY tool for predicting falls in acutely hospitalized patients in Japan by a multi-center study. A total of 113,413 patients admitted to four acute cares national university hospitals during the period from April 2010 to March 2012 were studied. Inpatient falls per 1,000 patient-days varied from 1.42 to 2.92 in the four hospitals. The STRATIFY score was calculated on the basis of data extracted electronically from the hospital information system. Although the distribution of STRATIFY scores differed significantly among the four hospitals, logistic regression analysis and survival analysis showed that the proportion of high-risk patients who fell was significantly larger than the proportion of low-risk patients in all of the four hospitals. The odds ratio and hazard ratio for high-risk patients versus low-risk patients were 2.5 to 4.3 (combined estimate, 3.9 (95% confidence interval (95% CI), 2.1 to 7.6) and 1.8 to 5.1 (combined estimate, 3.1 (95% CI, 2.1 to 4.6)), respectively. The results suggest that the STRATIFY tool can be used as a screening tool to detect patients at high risk for falls in a Japanese acute care setting as used commonly in other countries. </p>

scholarly journals Pre-NELA vs NELA – has anything changed, or is it just an audit exercise?

2016 ◽  
Vol 98 (8) ◽  
pp. 554-559 ◽  
Author(s):  
M Mak ◽  
AR Hakeem ◽  
V Chitre
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Possum Score ◽  
Operative Severity Score ◽  
Risk Patients ◽  
Set Up

BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust’s adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months – 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.

Cardiovascular risk assessment in diabetes and pre-diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 923-924
Author(s):  
Nikolaus Marx
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Target Organ Damage ◽  
Risk Scores ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Patients with diabetes exhibit an increased propensity to develop cardiovascular disease with an increased mortality. Early risk assessment, especially for coronary artery disease, is important to initiate therapeutic strategies to reduce cardiovascular risk. This chapter reviews the current literature on risk scores in patients with type 1 and type 2 diabetes and summarizes the role of risk assessment based on biomarkers and different imaging strategies. Current guidelines recommend that patients with diabetes are characterized as high-risk or very high-risk patients. In the presence of target organ damage or other risk factors such as smoking, marked hypercholesterolaemia, or hypertension, patients with diabetes are classified as very high-risk patients while most other people with diabetes are categorized as high-risk patients.

O20 Quick, simple and just as effective—comparing pm: L3 ratio to NELA, P-POSSUM and NSQIP scores in assessing mortality risk for emergency laparotomy

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
J Y Ming ◽  
M Holmes ◽  
P Pockney ◽  
J Gani
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Tool ◽  
Risk Assessment Tool ◽  
Emergency Laparotomy ◽  
Routine Practice ◽  
High Risk Patients ◽  
Acs Nsqip ◽  
Psoas Muscles ◽  
Risk Patients

Abstract Introduction Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle: L3 vertebrae (PM: L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Result PM: L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042–1.122; range 0.141–3.934). PM: L3 ratio is significantly lower (P &lt; 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746–0.984]) and 90 days (mean 0.888 [95%CI 0.768–1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033–1.179], 90 day mean 1.112 [95% CI 1.070–1.154]). These associations are similar to those calculated by established risk assessment models. Conclusion PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. Take-home Message PM: L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy. It is comparable to NELA, P-POSSUM and ACS-NSQIP.

Venous thromboembolism prevention in medical patients: a framework for improving practice

2011 ◽  
Vol 26 (2) ◽  
pp. 62-68 ◽  
Author(s):  
P G Vaughan-Shaw ◽  
C Cannon
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Clinical Excellence ◽  
Medical Patients ◽  
High Risk Patients ◽  
Venous Thromboembolism Prevention ◽  
Risk Patients ◽  
A Prospective Study ◽  
Pharmacological Thromboprophylaxis

Objective Medical inpatients have been shown to be at risk of venous thromboembolism (VTE) including fatal pulmonary emboli. Several studies have shown that pharmacological thromboprophylaxis significantly reduces the rates of VTE, yet studies published to date have shown a considerable underuse of thromboprophylaxis in medical patients. This study assesses the current use of thromboprophylaxis in medical patients at our institution and aims to identify simple strategies to improve practice. Design A prospective study of thromboprophylaxis prescription was undertaken on three occasions over a 12-month period. Patients were stratified according to the number of risk factors and standards of thromboprophylaxis assessed according to risk. After the first round of data collection, results were presented, a local guideline was developed and a risk assessment was added to the clerking pro forma. Results There were 122 patients in the first round, 101 in the second and 163 in the third. Eligible moderate and high-risk patients receiving a low molecular weight heparin (LMWH) increased from 31% to 63% ( P < 0.005) over the study period. Prescription of thromboembolic deterrent (TED) stockings in those contraindicated to LMWH increased from 23% to 35% although this was not statistically significant ( P = 0.08), and the percentage of high-risk patients correctly receiving LMWH, TED stockings or both increased from 22% to 62% ( P < 0.0005). Documentation of contraindications to thromboprophylaxis increased from 0% to 59% ( P < 0.0005). Conclusion This paper demonstrates an initial rate of thromboprophylaxis use considerably less than the ENDORSE trial. However the strategies employed following initial audit resulted in a significant increase in the prescription of both mechanical and pharmacological thromboprophylaxis. This example demonstrates the role of audit education and a risk assessment in stimulating change. Such strategies could be used to ensure compliance to recently published National Institute of Clinical Excellence VTE guidelines. Furthermore this example could be generalized to improve other aspects of care.

Risk assessment of immediate delivery in asymptomatic high risk patients with a cervical length of 0mm

2004 ◽  
Vol 191 (6) ◽  
pp. S188
Author(s):  
Israel Hendler ◽  
Nahla Khalek ◽  
Sean Blackwell ◽  
Emmanuel Bujold ◽  
Jerrie Refuerzo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Cervical Length ◽  
High Risk Patients ◽  
Risk Patients
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